Outcome of treatment for dislocation after primary total hip replacement

Kotwal, Rahul; Ganapathi, M.; John, Anish; Maheson, M; Jones, Stephen A.

doi:10.1302/0301-620x.91b3.21274

Cited by 111 publications

(64 citation statements)

References 35 publications

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“…Five patients had soft tissue destruction to the point where a portion or all of the hip abductor insertion required attempted repair. Patient outcome scores were found to be fair, regardless of the measurement tool used, and comparable to other studies for revision for pseudotumour 23 , MoM revision cases [24][25][26] , and revision for instability in MoP THR 21 .…”

Section: Discussionsupporting

confidence: 79%

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Delayed dislocation following metal-on-polyethylene arthroplasty of the hip due to ‘silent’ trunnion corrosion

Lash

Whitehouse

Greidanus

et al. 2016

The Bone & Joint Journal

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We present a case series of metal on polyethylene total hip replacement (MoP THR) with delayed onset dislocation, associated with unrecognised adverse local tissue reaction to trunnion corrosion and pseudotumour formation. The diagnosis was not suspected in nine of the ten cases, despite the subspecialty nature of the unit at which they were treated. Instead, it was identified at the time of revision surgery, because of the intraoperative findings, subsequently confirmed by histological examination of the resected tissue. Preoperative assessment and culture results ruled out infection.A variety of treatment strategies were employed, including tumour resection and efforts to avoid recurrent dislocation. The rate of complications was high and included three deep infections, two cases with recurrent dislocation, and one recurrent pseudotumour. This series demonstrates that pseudotumour is an infrequent but important cause of delayed instability following MoP THR, and it is easy to overlook in the differential diagnosis, especially if the original implant alignment is less than optimal, leading to an assumption of component malalignment as the cause of the dislocation.Revision is complex, requiring resection of the pseudotumour and modification of the reconstruction. The risk of postoperative complication is high.

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Section: Discussionsupporting

confidence: 79%

“…The pattern of presentation in this series is consistent with this because the time from index surgery to revision was just under six years (mean 57 months). This contrasts with revision for early instability in MOP THR, which is usually required within 6 months of index surgery 21 .…”

Section: Discussionmentioning

confidence: 99%

Delayed dislocation following metal-on-polyethylene arthroplasty of the hip due to ‘silent’ trunnion corrosion

Lash

Whitehouse

Greidanus

et al. 2016

The Bone & Joint Journal

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“…The constraining force of the ring is greater than 600 lbs for the 32-mm liner and 325 lbs for the 28-mm liner [50]. The leveraged torque to disengage the femoral head was 150 inch-lbs [30]. The cutouts are designed to reduce impingement in full flexion with internal rotation and in extension with external rotation as well as to maximize ROM.…”

Section: Appendix 1: Devices Examined In This Studymentioning

confidence: 99%

Constrained Cups Appear Incapable of Meeting the Demands of Revision THA

Noble

Durrani

Usrey

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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Background Failure rates of constrained cups for treating recurrent dislocation in revision THA range from 40% to 100%. Although constrained liners are intended to stabilize the hip by mechanically preventing dislocation, the resulting loss of range of motion may lead to impingement and, ultimately, implant failure. Questions/purposes We therefore documented the mechanisms of failure of constrained acetabular cups in revision THA and determined the type and severity of damage (wear, fracture, and impingement) that occurs in situ.Methods We retrieved 57 constrained components of four different designs at revision THA and examined for the presence of rim impingement, oxidation, cracks within the liner, backside wear, pitting, scratching, abrasion, burnishing, and the presence of embedded particles. Articular wear was calculated from the volume of the concave articular bearing surface, which was measured using the fluid displacement method. Results Failure of the locking ring was responsible for 51% of failures, whereas 28% of revisions were the result of acetabular cup loosening, 6% backside wear, and 22% infection. Impingement damage of the rim of the polyethylene liner was seen in all retrievals with moderate or severe damage in 54%. The average volumetric wear rate of the articular surface was 95 mm 3 /year. Conclusions Failure of the locking liner ring and loosening of the acetabular cup are the primary causes of mechanical failure with constrained liners; polyethylene is an inadequate material for restricting motion of the hip to prevent instability. The durability of these devices is unlikely to improve unless the mechanical demands are modified through increased range of motion leading to less frequent rim impingement.

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“…A landmark review in 1982 by Woo and Morrey of over 10 000 primary THAs reported a dislocation rate of 3.2% [1] . Other studies have reported dislocation rates of 0.3% to 10% for primary THAs and up to 28% for revision THAs [2][3][4][5][6][7][8][9][10][11][12][13][14] . The risk of dislocation is influenced by patient factors such as age, sex, previous surgery, and cognitive or neurologic disorders as well as surgical factors, including surgical approach, choice of implant, soft tissue and surgeon experience [13][14][15] .…”

Section: Introductionmentioning

confidence: 99%

Instability after total hip arthroplasty

Werner

Brown

2012

WJO

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Instability following total hip arthroplasty (THA) is an unfortunately frequent and serious problem that requires thorough evaluation and preoperative planning before surgical intervention. Prevention through optimal index surgery is of great importance, as the management of an unstable THA is challenging even for an experienced joints surgeon. However, even after well-planned surgery, a significant incidence of recurrent instability still exists. Non-operative management is often successful if the components are well-fixed and correctly positioned in the absence of neurocognitive disorders. If conservative management fails, surgical options include revision of malpositioned components; exchange of modular components such as the femoral head and acetabular liner; bipolar arthroplasty; tripolar arthroplasty; use of a larger femoral head; use of a constrained liner; soft tissue reinforcement and advancement of the greater trochanter.

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Outcome of treatment for dislocation after primary total hip replacement

Cited by 111 publications

References 35 publications

Delayed dislocation following metal-on-polyethylene arthroplasty of the hip due to ‘silent’ trunnion corrosion

Delayed dislocation following metal-on-polyethylene arthroplasty of the hip due to ‘silent’ trunnion corrosion

Constrained Cups Appear Incapable of Meeting the Demands of Revision THA

Instability after total hip arthroplasty

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